Two Tears for Suboxone

Why is the addiction-recovery world so adamantly against a pill that helps users kick heroin?

Imagine you’ve been diagnosed with a fatal disease and you have two options for treatment. In the first option the doctor directs you to an Institution where the staff speak in metaphors. You spend a month in the Institution learning that your disease is like a tree planted in your brain. That thought you just had? A leaf of the tree of your disease. The people in the Institution teach you how to use mysterious spiritual powers to destroy the root of your disease. It works like this:

RECALL those moments scattered through your life when something or someone parted the fabric of your thoughts and you saw serene waveless ocean and knew nothing bad could ever happen.

PERFORM certain activities that draw this serene waveless ocean up through your gestures and into your instincts to rain down through your thoughts and drown the root of the tree of your disease.

ATTEND meetings where you repeat the long version of these steps holding hands with a group of others.

That’s the first option for treating your fatal disease. In the second option the doctor gives you a prescription for Suboxone pills and tells you to take them as directed.

Which method would you choose? I should say, in case it isn’t obvious, that method two is much more effective than method one. I chose method one.

I recovered from my addiction to heroin using the traditional recovery program based on the 12 steps of Alcoholics Anonymous, subsequently adapted by Narcotics Anonymous. Broke, demented, and suicidal, I was arrested and charged with felony possession of heroin on New Year’s Eve 2001. The judge suspended my sentence, in part because I agreed to participate in 12-step recovery meetings.

I entered a 28-day treatment center where they explained to me that the steps are intended to induce a spiritual awakening that will dissolve my desire to get high. Because spiritual awakenings are famous for disappearing from day to day or even from one minute to the next, the steps—and attendance at 12-step meetings—are designed to make that spiritual awakening a permanent, renewable, and routine feature of everyday life.

My awakening came after about two weeks in the center. It was weird. I went out for a walk by myself and saw an old chair abandoned in the middle of a field. The moment I saw the empty chair I suddenly knew that my thoughts were hollow. Then my thoughts were gone and the sun was coming up inside the landscape. Inside the old chair. Inside each withered blade of grass.

I walked back to the center and told my therapist, and he nodded and wrote something down on a form on his clipboard.

What happened in the field? I don’t know. As far as religion goes, I’ve always been somewhere between atheist and agnostic. Before I left the center I asked my therapist what he thought was behind these spiritual awakenings. He said it didn’t really matter.

When I got out of the treatment center I made a list of things to do every day—meditate, go to an NA meeting, exercise, keep a journal, and do something good for someone else. It worked. I haven’t used heroin, or alcohol or pot, or any other intoxicating chemical for more than 12 years. I even quit smoking a decade ago. I’m healthy and emotionally stable. I have a good job. I live in a nice neighborhood with people who smile when they see me. Their smiles are real. They don’t expect me in their house at two a.m. with a rope and a mask.

Method one worked for me. Until recently I had a sense that it could work for you too.

Now my sense of things has changed.

***

I’ve worked with addicts in various volunteer capacities since I had six months clean. For one reason or another, most of the people I worked closely with when I lived in Michigan and Florida weren’t heroin addicts. Alcohol was their drug of choice. Or pot. Or Xanax or something. The AA method works the same whatever the drug, so I didn’t think about this too much. Sometimes the addicts I worked with relapsed, but sometimes they came back.

Then I moved to Ohio, and a strange thing started to happen. Nearly all the younger people I met in recovery, all the guys who asked me to sponsor them in the program, were heroin addicts. Gradually I learned that Northeast Ohio was in the midst of a “heroin epidemic,” partly due to Vicodin or Percocet addicts turning to dope for a cheaper alternative.

Area NA meetings filled up with heroin addicts. They couldn’t stay clean. It was as if each meeting was divided into two sections. The smaller group was made up of us old-timers, people who had been coming to meetings for years. The larger group contained newcomers, a shifting mass of new faces every week.

And even though the meetings were teeming, they felt tiny, since there were only a handful of people you’d see more than a few times. After a while a newcomer’s face began to seem insubstantial. It lacked permanence. Sometimes, we old-timers would find ourselves speaking THE FAMILIAR PLATITUDES to each other through a newcomer.

The newcomers were disappearing. They died by the score. We handed out phone numbers, books, hugs. They vanished. Just a few of the hundreds of guys I gave my phone number to came back. When I asked myself what makes them different, the answer, though it appears obvious in retrospect, surprised me. Most of them were taking suboxone.

Suboxone is the successor to methadone in what’s known in the world of addiction medicine as Medication Assisted Therapy. It’s a hybrid, made up of buprenorphine, an opiate that effectively eliminates cravings and withdrawal symptoms, and naloxone, which blocks the effects of any other opiate, to discourage addicts from slipping.

As a treatment for opiate addiction, methadone has some major drawbacks. One of them is that methadone is generally distributed through government approved clinics, often requiring addicts to come to the clinic on a daily basis to get their supply. Since there aren’t many clinics, addicts typically must travel significant distances each day, interfering with their efforts to operate as normal members of society.

Suboxone, on the other hand, is usually prescribed by doctors on a monthly basis. It’s dispensed at doses that don’t produce a high and that don’t impair physical or mental functioning — in that it seems similar to the antidepressants often prescribed in traditional, abstinence-based recovery.

Jason Jerry, a doctor who practices addiction medicine at the Cleveland Clinic, told me that the evidence for the superiority of medication-assisted therapy, using drugs like suboxone, over abstinence-based recovery is overwhelming. According to a recent study, opiate addicts who use the method I used have an 86% chance of relapsing within two months. Studies of addicts treated with Suboxone, on the other hand, show three month retention rates of 52% to 79%. In an especially striking statistic, 38% of addicts receiving suboxone remain in recovery after five years. Heroin addicts on suboxone cut their risk of death by overdose even more dramatically when compared with traditional recovery methods.

You’d think that anything that can help save a heroin addict’s life would be seen as a good thing, especially among recovering addicts themselves. So why, then, when I touted suboxone at an NA meeting with a bunch of regulars did they look at me as if I’d gone insane?

The problem is that many of the regulars at NA meetings don’t believe that you can be clean if you’re taking suboxone. NA even has a policy stating that people on medication-assisted therapy can’t speak at meetings and can’t describe themselves at meetings as clean.

When I talk to a newcomer who’s trying to kick dope, I recommend that they speak to their doctor about suboxone, but my new approach has earned me only scorn at meetings.

“That’s like telling someone that smoking crack will get their mind off booze,” one said.

“And it will,” said another.

“But that’s not recovery,” said the first guy. “Recovery is total abstinence from all mood-altering drugs. Just like it says in our literature.”

“But,” I protested. “Lots of us take antidepressants. That’s a mood-altering drug. And yet we say we’re clean.”

“Zoloft isn’t crack,” he replied.

“Mike,” one asked quietly. “How did you get clean?”

“That’s not the point,” I said. “We’re not talking about me.”

“Your recovery is based on a spiritual awakening,” he said. “And you are trying to deny that awakening to these addicts. You are trying to prevent them from getting what you have!”

The attitude expressed by my NA friends that night drives the medical community nuts. The doctors stand around in shock and ask themselves: Don’t these people get it? The abstinence-based method just doesn’t work that well. We have decades of data. It’s not so different from a Christian Scientist refusing to let a child with an infection take penicillin.

But I also have to admit that I know how the folks who yelled at me feel. The old-timers at meetings, they know the old method doesn’t work so well. They’re not stupid. It fails, time after time. They’ve seen it fail for years, for decades. Of course it fails! It’s a completely bizarre contraption with an enigma for an engine and pure mystery for gas. The fact that it fails isn’t amazing at all. What’s amazing is that it sometimes works.

People sometimes compare going to NA meetings to a diabetic taking her insulin. But NA isn’t like insulin. Diabetics who benefit from insulin are grateful, but they’re not amazed. The addicts who’ve recovered through the abstinence method are amazed.

Still, I’m committed to supporting addicts who choose to take suboxone. I’ll keep fighting for their right to participate as equals in the recovery community.

But imagine that an old man gives you an empty bottle, and tells you that when you rub it a genie will appear to grant your deepest wish. And imagine you discover that in fact the genie appears only once every ten times you rub it. Would you return the bottle? I doubt it.

Of course, if your friend got hit by a car and lay bleeding on the pavement, you’d probably call 911 before trying the spirit. That’d be right thing to do. You don’t want him bleeding out while you’re patiently rubbing a bottle. Call the doctors. That’s what I would do. And when the ambulance comes and fixes your friend up, you wouldn’t feel sorry for him because he wasn’t healed by a mysterious spirit. Would you?

Okay, maybe you’d feel a little sorry for him. You wouldn’t cry though. Or if you did, you wouldn’t cry much. Two tears, maybe.